The objective and dynamic documentation of the knee kinematics in ambulatory children with spastic cerebral palsy and the examination of possible causes of differences when compared to normals.

17 ambulatory patients with an average age of 10,5 years (6–17 years) with cerebral palsy, spastic diplegia where examined clinically including Duncan-Ely test. They were also examined with 3-D instrumented gait analysis. The Elite system with six cameras was used and the knee kinematics in the sagittal plane was recorded.

Almost all patients (16/17) had a positive Duncan-Ely test during clinical examination. The knee kinematics in the sagittal plane showed that in 20/34 knees the range of motion was decreased compared to normal values. In 30/34 knees there was a delayed maximum knee flexion in swing phase and in 16/34 knees the amplitude of the maximum knee flexion was decreased compared to normals. Patients with severe crouch or mild rectus spasticity had almost normal knee flexion.

Foot clearance in swing phase is one of the basic prerequisites of normal gait. Patients with spastic cerebral palsy who are able to walk have an impaired foot clearance because of the pathological action of the rectus femoris.

In our study the majority of the patients with clinically confirmed rectus spasticity had decreased timing and amplitude of max. knee flexion in swing. In patients with severe co-contraction of the knee flexors and extensors max. knee flexion within normal range. Therefore it should not be considered as the only evaluation parameter in rectus femoris spasticity.

Purpose: The purpose of our study is to estimate the effectiveness of Parecoxib in the post surgical analgesia in the fractures of the hip joint in comparison with the usage of the combination of Diclofenac ant Pethidine

Material and methods: We have carried out a prospective randomized clinical study, during the period January 2003-July 2004, on 90 patients were operated with fractures of the hip joint. We examined two similar groups of patients concerning the age, the type of fracture and the type of anaesthesia. In group A, consisting of 35 patients, we provided 40 mg of Parecoxib i.v., as postsurgical analgesia, twice a day and in Group B, of 55 patients, we provided the combination of Diclofenac 75mg i.m. twice a day and Pethidine i.m. in case of persisting pain.

The intensity of pain was estimated by the Pain Intensity Scale ( PIS ).

Results: In Group A the PIS was 2.5 ± 0.8, and none of the patients needed supplementary analgesic. In Group B the PIS was 3.2 ± 0.8 and 21 (38.3%) patients needed supplementary analgesics (Pethidine).

In the use of Parecoxib no side effects were noticed (decrease BP, vomiting etc).

Conclusion: Parecoxib is more effective in the post surgical analgesia than Diclofenac and Pethidine in the fractures of the hip joint. It is easier to administer (i.v) and is also seems to be safe (no side effects were noticed). Therefore, we suggest that it should be the drug of choice in the post surgical analgesia of the fractures of the hip joint.